The Effect of Patients’ Understanding of Sling Necessity and Home Assistance on Sling Wear After Shoulder Surgery

Abstract

Background: Perioperative education and socioeconomic factors influence patient behavior. Recent evidence has suggested that sling compliance is associated with improved outcomes after shoulder surgery; it is important to investigate factors that influence sling compliance. Purpose: To determine the associations between postoperative sling wear and patients’ understanding of sling necessity, postoperative home assistance, and social deprivation. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 66 patients were prospectively enrolled from 2018 to 2020 if they were ≥18 years of age and undergoing shoulder surgery requiring a sling for at least 1 month postoperatively. Sling wear was measured using a temperature-sensing device. At 6 weeks postoperatively, patients’ understanding for sling necessity was determined by their response to a question on the Medical Adherence Measure questionnaire, “Why did you have to wear a shoulder sling?” The Patient Understanding Grading Scale (PUGS) was developed to quantify patient responses. PUGS was graded 1 to 3, with grade 1 corresponding to the least technical knowledge. Patient characteristics, social deprivation (Area Deprivation Index [ADI]), and home assistance were additionally analyzed. Results: There were no significant differences in baseline characteristics between patients when stratified by PUGS grade. Multivariable linear regression analysis for total hours of sling wear per week showed that patients with PUGS grade 2 (β, 48.2 hours; P = .007) and grade 3 (β, 59.5 hours; P = .003) wore their slings significantly more than grade 1 patients. Patients with home assistance had significantly greater day hours (73.5 ± 33.0 vs 44.0 ± 24.5 hours; P = .037) of sling wear per week, but there was no difference in night sling hours. Patients older than 60 years wore their slings significantly more, while men and those with a higher body mass index (BMI) wore their slings significantly less. ADI was not significantly associated with sling wear. Conclusion: This study demonstrates that patients with greater understanding for sling necessity, those with home assistance, and patients >60 years have greater sling wear, while male patients and those with a higher BMI have lower sling compliance. ADI was not a significant contributor.

Feasibility of Using a GENEActiv Accelerometer with Triaxial Acceleration and Temperature Sensors to Monitor Adherence to Shoulder Sling Wear Following Surgery

“…The authors reported that self-reported adherence was significantly less than the sensor-measured adherence and concluded self-reported adherence is unreliable [21]. Another prospective study by Livesey et al assessed sling wear adherence in 66 post-operative shoulder patients for one month after their procedures using similar temperature sensors [22]. The study aimed to evaluate the associations between postoperative sling wear adherence and patients' understanding of sling necessity, postoperative home assistance, and social deprivation.…”

Fostering Compliance

“…In their study in this issue of the AJSM , Livesey and colleagues 8 set out to determine whether patients’ understanding of the reasons for wearing a sling correlated with their actual use of this device. Note that they were not seeking to determine whether sling wear influenced the outcomes of surgery, just whether the patients followed the surgeons’ instructions.…”